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Aletras G, Stratinaki M, Bachlitzanaki M, Georgopoulou T, Foukarakis EG. A Rare Cause of Recurrent Pericarditis. Cureus 2024; 16:e53602. [PMID: 38318274 PMCID: PMC10839823 DOI: 10.7759/cureus.53602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2024] [Indexed: 02/07/2024] Open
Abstract
Recurrent pericarditis poses a significant challenge to clinicians, particularly when patients are unresponsive or intolerant to conventional treatments. Accurate diagnosis of recurrent pericarditis, potentially facilitated by collaboration with other medical specialties, is crucial for ensuring timely and appropriate treatment of symptoms and prevention of further episodes. We present a case of a 52-year-old male patient with a history of multiple episodes of pericarditis, who was admitted to the Cardiology Department due to another recurrence. The first episode of pericarditis was diagnosed nearly a year before his current hospitalization. Initially, the patient received high doses of Ibuprofen and colchicine, but there was no favorable response to this treatment regimen. At that point, intravenous prednisolone was initiated, which led to clinical and laboratory improvement. Since then, the patient had experienced two more recurrences while tapering off prednisolone. Immunological tests, Mantoux tuberculin skin test, and chest and abdominal computed tomography (CT) had revealed no evidence of an underlying cause. On admission the patient was febrile and the electrocardiogram showed diffuse ST elevation and PR depression in leads I, II, aVF, V2-V6. Bedside echocardiogram revealed a small pericardial effusion and since the chest X-ray was normal and no other potential infection sites were identified, the diagnosis of recurrent pericarditis was established. During his current hospitalization, intravenous prednisolone was initiated, colchicine was continued and a more detailed history was taken, raising the suspicion upon the presence of an auto-inflammatory disease. Genetic investigation identified an uncommon heterozygous mutation in the familial Mediterranean fever gene (MEFV) and after consideration of patient's history, familial Mediterranean fever was diagnosed. Anakinra was initiated on top of colchicine and gradual tapering of corticosteroids and the patient showed significant improvement, with no other recurrence during the two-year follow-up.
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Affiliation(s)
- Georgios Aletras
- Department of Cardiology, Venizeleion General Hospital, Heraklion Crete, GRC
| | - Maria Stratinaki
- Department of Cardiology, Venizeleion General Hospital, Heraklion Crete, GRC
| | - Maria Bachlitzanaki
- Second Department of Internal Medicine, Venizeleion General Hospital, Heraklion Crete, GRC
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Bachlitzanaki M, Aletras G, Bachlitzanaki E, Messaritakis I, Koukias S, Koulouridi A, Bachlitzanakis E, Kaloeidi E, Vakonaki E, Kontopodis E, Androulakis N, Chamilos G, Mavroudis D, Ioannou P, Kofteridis D. Evaluation of Febrile Neutropenia in Hospitalized Patients with Neoplasia Undergoing Chemotherapy. Microorganisms 2023; 11:2547. [PMID: 37894205 PMCID: PMC10609470 DOI: 10.3390/microorganisms11102547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/07/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Febrile neutropenia (FN) is a common but serious complication encountered in patients with cancer and is associated with significant morbidity and mortality. In this prospective study, 63 patients with solid tumors under chemotherapy or immunotherapy were admitted to the hospital due to febrile neutropenia, confirmed through clinical or microbiological documentation. The aim of this study was to provide a comprehensive overview of the epidemiological and microbiological characteristics of hospitalized neutropenic patients with solid tumors undergoing treatment. Additionally, we aimed to assess the duration of neutropenia and identify factors influencing patient outcomes. The median age of patients was 71 ± 10.2 years, most of which were males (66.7%), and the primitive tumor location was the lung (38.1%), with most patients (82.5%) being at disease stage IV. The median duration of neutropenia was three days (range 1-10), and, notably, mucositis was significantly associated with neutropenia lasting ≥3 days (p = 0.012). Patients with lung cancer (38.1%) and patients with stage IV disease (82.5%) presented a higher risk of FN, although these differences did not reach statistical significance. The site of infection was identifiable in 55.6% of patients, with positive cultures detected in 34.9% and positive blood cultures (BC) drawn in 17.5% of cases. Gram-positive bacteria were the predominant causative agents in BC (63.6%), with Staphylococci being the most prevalent among them (66.7%). The median duration of hospitalization was nine days (range, 3-43 days), and most patients showed improvement or cure of infection (16.9% and 74.6%, respectively). Among recorded risk factors, the Eastern Cooperative Oncology Group (ECOG) performance status (PS) appears to be statistically significant. Patients with an impaired PS score (2-4) experienced worse outcomes and higher likelihood of mortality (p = 0.004). Regarding the outcome, a longer duration of neutropenia was also statistically significant (p = 0.050). Of the patients, 12.7% ultimately succumbed to their conditions, with 37.5% attributed to infections. FN is a common yet serious complication in solid tumor patients. Adequate knowledge of the predictors of mortality and the microbiological causes are of utmost importance to allow accurate diagnosis and prompt treatment as they significantly influence patient outcomes.
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Affiliation(s)
- Maria Bachlitzanaki
- Department of Internal Medicine, Venizeleion General Hospital of Heraklion, 71409 Heraklion, Greece
- School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - George Aletras
- Department of Cardiology, Venizeleion General Hospital of Heraklion, 71409 Heraklion, Greece
| | - Eirini Bachlitzanaki
- Department of Cardiology, Venizeleion General Hospital of Heraklion, 71409 Heraklion, Greece
| | - Ippokratis Messaritakis
- Laboratory of Translational Oncology, Medical School, University of Crete, 70013 Heraklion, Greece
| | - Stergos Koukias
- Department of Internal Medicine, Venizeleion General Hospital of Heraklion, 71409 Heraklion, Greece
| | - Asimina Koulouridi
- Department of Medical Oncology, University General Hospital of Heraklion, 70013 Heraklion, Greece
| | | | - Eleni Kaloeidi
- Department of Surgery, Venizeleion General Hospital of Heraklion, 71409 Heraklion, Greece
| | - Elena Vakonaki
- Laboratory of Toxicology, Department of Anatomy, School of Medicine, University of Crete, 70013 Heraklion, Greece
| | - Emmanouil Kontopodis
- Department Medical Oncology, Venizeleion General Hospital of Heraklion, 71409 Heraklion, Greece
| | - Nikolaos Androulakis
- Department Medical Oncology, Venizeleion General Hospital of Heraklion, 71409 Heraklion, Greece
| | - Georgios Chamilos
- School of Medicine, University of Crete, 71003 Heraklion, Greece
- Department of Clinical Microbiology and Microbial Pathogenesis, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Dimitrios Mavroudis
- School of Medicine, University of Crete, 71003 Heraklion, Greece
- Department of Medical Oncology, University General Hospital of Heraklion, 70013 Heraklion, Greece
| | - Petros Ioannou
- School of Medicine, University of Crete, 71003 Heraklion, Greece
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Diamantis Kofteridis
- School of Medicine, University of Crete, 71003 Heraklion, Greece
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, 71110 Heraklion, Greece
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Tsatsakis A, Oikonomopoulou T, Nikolouzakis TK, Vakonaki E, Tzatzarakis M, Flamourakis M, Renieri E, Fragkiadaki P, Iliaki E, Bachlitzanaki M, Karzi V, Katsikantami I, Kakridonis F, Hatzidaki E, Tolia M, Svistunov AA, Spandidos DA, Nikitovic D, Tsiaoussis J, Berdiaki A. Role of telomere length in human carcinogenesis (Review). Int J Oncol 2023; 63:78. [PMID: 37232367 PMCID: PMC10552730 DOI: 10.3892/ijo.2023.5526] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023] Open
Abstract
Cancer is considered the most important clinical, social and economic issue regarding cause‑specific disability‑adjusted life years among all human pathologies. Exogenous, endogenous and individual factors, including genetic predisposition, participate in cancer triggering. Telomeres are specific DNA structures positioned at the end of chromosomes and consist of repetitive nucleotide sequences, which, together with shelterin proteins, facilitate the maintenance of chromosome stability, while protecting them from genomic erosion. Even though the connection between telomere status and carcinogenesis has been identified, the absence of a universal or even a cancer‑specific trend renders consent even more complex. It is indicative that both short and long telomere lengths have been associated with a high risk of cancer incidence. When evaluating risk associations between cancer and telomere length, a disparity appears to emerge. Even though shorter telomeres have been adopted as a marker of poorer health status and an older biological age, longer telomeres due to increased cell growth potential are associated with the acquirement of cancer‑initiating somatic mutations. Therefore, the present review aimed to comprehensively present the multifaceted pattern of telomere length and cancer incidence association.
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Affiliation(s)
- Aristidis Tsatsakis
- Laboratory of Toxicology, School of Medicine, University of Crete, 71003 Heraklion
| | - Tatiana Oikonomopoulou
- Laboratory of Toxicology, School of Medicine, University of Crete, 71003 Heraklion
- Department of Anatomy, School of Medicine, University of Crete, 71003 Heraklion
| | - Taxiarchis Konstantinos Nikolouzakis
- Laboratory of Toxicology, School of Medicine, University of Crete, 71003 Heraklion
- Department of Anatomy, School of Medicine, University of Crete, 71003 Heraklion
| | - Elena Vakonaki
- Laboratory of Toxicology, School of Medicine, University of Crete, 71003 Heraklion
| | - Manolis Tzatzarakis
- Laboratory of Toxicology, School of Medicine, University of Crete, 71003 Heraklion
| | | | - Elisavet Renieri
- Laboratory of Toxicology, School of Medicine, University of Crete, 71003 Heraklion
| | | | - Evaggelia Iliaki
- Laboratory of Microbiology, University Hospital of Heraklion, 71500 Heraklion
| | - Maria Bachlitzanaki
- Department of Medical Oncology, Venizeleion General Hospital of Heraklion, 71409 Heraklion
| | - Vasiliki Karzi
- Laboratory of Toxicology, School of Medicine, University of Crete, 71003 Heraklion
| | - Ioanna Katsikantami
- Laboratory of Toxicology, School of Medicine, University of Crete, 71003 Heraklion
| | - Fotios Kakridonis
- Department of Spine Surgery and Scoliosis, KAT General Hospital, 14561 Athens
| | - Eleftheria Hatzidaki
- Department of Neonatology and Neonatal Intensive Care Unit (NICU), University Hospital of Heraklion, 71500 Heraklion
| | - Maria Tolia
- Department of Radiation Oncology, University Hospital of Crete, 71110 Heraklion, Greece
| | - Andrey A. Svistunov
- Department of Pharmacology, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119146 Moscow, Russia
| | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Dragana Nikitovic
- Laboratory of Histology-Embryology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - John Tsiaoussis
- Department of Anatomy, School of Medicine, University of Crete, 71003 Heraklion
| | - Aikaterini Berdiaki
- Laboratory of Histology-Embryology, School of Medicine, University of Crete, 71003 Heraklion, Greece
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Koulouridi A, Karagianni M, Messaritakis I, Sfakianaki M, Voutsina A, Trypaki M, Bachlitzanaki M, Koustas E, Karamouzis MV, Ntavatzikos A, Koumarianou A, Androulakis N, Mavroudis D, Tzardi M, Souglakos J. Prognostic Value of KRAS Mutations in Colorectal Cancer Patients. Cancers (Basel) 2022; 14:cancers14143320. [PMID: 35884381 PMCID: PMC9313302 DOI: 10.3390/cancers14143320] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/04/2022] [Accepted: 07/07/2022] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Kirsten rat sarcoma viral oncogene homolog (KRAS)-mutated colorectal cancer (CRC) seems to have a different biological behavior and therapeutic approach compared with non-KRAS mutated CRC. Except for the proven predictive significance of KRAS mutations in CRC patients, their prognostic significance is still under evaluation. Our study shows that 93.2% of RAS-mutated patients were KRAS mutants, with G12D being the most common subtype. KRAS G12D mutation is correlated with better overall survival (OS). KRAS G12C mutations may indicate worse prognosis regarding progression free (PFS) and OS, as well as exon 4 and exon 3 KRAS mutations for PFS and OS, respectively. Further studies are warranted to confirm these results. Abstract Colorectal cancer (CRC) remains a major public health issue. The detection of parameters that affect CRC prognosis is of great significance. KRAS mutations, play a crucial role in tumorigenesis with a strong predictive value. KRAS-mutated stage-IV CRC patients gain no benefit of the anti-EGFR therapy. The KRAS G12C mutation subtype is under investigation for treatment regimens. The present study aimed to detect various RAS mutations in a cohort of 578 RAS-mutated CRC patients; 49% of them had de novo metastatic disease; 60% were male; 71.4% had left-sided tumors; and 94.6% had a good performance status. KRAS mutations were detected in 93.2% of patients, with KRAS G12D being the most common subtype (30.1%). KRAS mutations presented shorter progression-free (PFS) and overall survival (OS), compared with NRAS mutations, although not significantly (PFS: 13.8 vs. 18.5 months; p = 0.552; OS: 53.1 vs. 60.9 months; p = 0.249). KRAS G12D mutations presented better OS rates (p = 0.04). KRAS G12C mutation, even though not significantly, presented worse PFS and OS rates. KRAS exon 3 and 4 mutations presented different PFS and OS rates, although these were not significant. Concluding, KRAS G12D and G12C mutations lead to better and worst prognosis, respectively. Further studies are warranted to validate such findings and their possible therapeutic implication.
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Affiliation(s)
- Asimina Koulouridi
- Laboratory of Translational Oncology, Medical School, University of Crete, 70013 Heraklion, Greece; (A.K.); (M.K.); (M.S.); (A.V.); (M.T.); (D.M.)
| | - Michaela Karagianni
- Laboratory of Translational Oncology, Medical School, University of Crete, 70013 Heraklion, Greece; (A.K.); (M.K.); (M.S.); (A.V.); (M.T.); (D.M.)
| | - Ippokratis Messaritakis
- Laboratory of Translational Oncology, Medical School, University of Crete, 70013 Heraklion, Greece; (A.K.); (M.K.); (M.S.); (A.V.); (M.T.); (D.M.)
- Correspondence: (I.M.); (J.S.); Tel.: +30-2810-394926 (I.M.)
| | - Maria Sfakianaki
- Laboratory of Translational Oncology, Medical School, University of Crete, 70013 Heraklion, Greece; (A.K.); (M.K.); (M.S.); (A.V.); (M.T.); (D.M.)
| | - Alexandra Voutsina
- Laboratory of Translational Oncology, Medical School, University of Crete, 70013 Heraklion, Greece; (A.K.); (M.K.); (M.S.); (A.V.); (M.T.); (D.M.)
| | - Maria Trypaki
- Laboratory of Translational Oncology, Medical School, University of Crete, 70013 Heraklion, Greece; (A.K.); (M.K.); (M.S.); (A.V.); (M.T.); (D.M.)
| | - Maria Bachlitzanaki
- Medical Oncology Unit, Pananio-Venizelio General Hospital of Heraklion, 71500 Heraklion, Greece; (M.B.); (N.A.)
| | - Evangelos Koustas
- Molecular Oncology Unit, Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.K.); (M.V.K.)
| | - Michalis V. Karamouzis
- Molecular Oncology Unit, Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.K.); (M.V.K.)
| | - Anastasios Ntavatzikos
- Hematology Oncology Unit, Fourth Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.N.); (A.K.)
| | - Anna Koumarianou
- Hematology Oncology Unit, Fourth Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.N.); (A.K.)
| | - Nikolaos Androulakis
- Medical Oncology Unit, Pananio-Venizelio General Hospital of Heraklion, 71500 Heraklion, Greece; (M.B.); (N.A.)
| | - Dimitrios Mavroudis
- Laboratory of Translational Oncology, Medical School, University of Crete, 70013 Heraklion, Greece; (A.K.); (M.K.); (M.S.); (A.V.); (M.T.); (D.M.)
- Department of Medical Oncology, University General Hospital of Heraklion, 70013 Heraklion, Greece
| | - Maria Tzardi
- Laboratory of Pathology, Medical School, University of Crete, 70013 Heraklion, Greece;
| | - John Souglakos
- Laboratory of Translational Oncology, Medical School, University of Crete, 70013 Heraklion, Greece; (A.K.); (M.K.); (M.S.); (A.V.); (M.T.); (D.M.)
- Department of Medical Oncology, University General Hospital of Heraklion, 70013 Heraklion, Greece
- Correspondence: (I.M.); (J.S.); Tel.: +30-2810-394926 (I.M.)
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Kefalogianni T, Bachlitzanaki M, Klonaris D, Mylopotamitaki K, Malkidou N, Stavrianaki A, Karakostas E, Chalkiadaki E. P-255 Oropharyngeal squamous cell carcinoma metastatic to myocardium. A rare case report. Oral Oncol 2021. [DOI: 10.1016/s1368-8375(21)00538-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Spernovasilis N, Demetriou S, Bachlitzanaki M, Gialamas I, Alpantaki K, Hamilos G, Karantanas A, Gikas A. Characteristics and predictors of outcome of spontaneous spinal epidural abscesses treated conservatively: A retrospective cohort study in a referral center. Clin Neurol Neurosurg 2017; 156:11-17. [PMID: 28284111 DOI: 10.1016/j.clineuro.2017.02.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/20/2017] [Accepted: 02/24/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Recent studies have shown that in carefully selected patients, conservative treatment alone can be an option in the management of spinal epidural abscess (SEA). The aim of this study was to identify prognostic factors of outcome in patients with spontaneous SEA treated conservatively. PATIENTS AND METHODS A retrospective cohort study of all patients with spontaneous SEA treated with antibiotics alone from January 2012 to December 2015 was conducted in a 1200-bed tertiary referral center. Demographic, clinical, microbiological, and radiological characteristics were analyzed. Failure of medical treatment was defined as the need for delayed surgical intervention, no neurological improvement or deterioration, death due to the infection, or relapse after hospital discharge. RESULTS We identified 21 patients diagnosed with spontaneous SEA treated conservatively. Median age was 72 years and 10 patients were male. Eleven patients presented with radicular weakness and/or radicular sensory deficit, or incomplete cord injury. Inflammatory markers were markedly elevated in all patients. Thirteen patients were successfully treated with conservative treatment, while among 8 patients with treatment failure, 1 died due to the infection. Presence of serious neurological deficits and infection due to methicillin-resistant S. aureus (MRSA) were associated with failure of conservative treatment. Notably, neither the extension nor the location of the abscess on magnetic resonance imaging (MRI) was associated with failed medical management. CONCLUSIONS A significant proportion of patients with spontaneous SEA can respond to antibiotic treatment alone. However, in patients with infection due to MRSA or with severe neurological impairment, conservative management has an increased risk of failure.
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Affiliation(s)
- Nikolaos Spernovasilis
- Department of Internal Medicine, Infectious Diseases Unit, University Hospital of Heraklion, Heraklion, Greece
| | - Stelios Demetriou
- Department of Medical Imaging, University Hospital of Heraklion, Heraklion, Greece
| | - Maria Bachlitzanaki
- Department of Internal Medicine, "Venizelion" General Hospital of Heraklion, Heraklion, Greece
| | - Ioannis Gialamas
- Department of Internal Medicine, Infectious Diseases Unit, University Hospital of Heraklion, Heraklion, Greece
| | - Kalliopi Alpantaki
- Department of Orthopaedics and Traumatology, University Hospital of Heraklion, Heraklion, Greece; Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Georgios Hamilos
- Department of Internal Medicine, Infectious Diseases Unit, University Hospital of Heraklion, Heraklion, Greece; Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Apostolos Karantanas
- Department of Medical Imaging, University Hospital of Heraklion, Heraklion, Greece; Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Achilleas Gikas
- Department of Internal Medicine, Infectious Diseases Unit, University Hospital of Heraklion, Heraklion, Greece; Faculty of Medicine, University of Crete, Heraklion, Greece.
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Koutsovasilis A, Papazafiropoulou A, Sotiropoulos A, Peppas T, Grozou A, Bachlitzanaki M, Tamvakos E, Bousboulas S. Differences between rural and urban population considering prevalence of chronic complications among patients with type 2 diabetes mellitus. Atherosclerosis 2014. [DOI: 10.1016/j.atherosclerosis.2014.05.890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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